Question 1

A child that may warrant "watchful waiting" instead of prescribing an antibiotic for acute otitis media includes patients who: A) Are low risk with temperature of less than 39^oC or 102.2^oF B) Have reliable parents with transportation C) Are older than age 2 years D) All of the above

Accepted Answer

All of the above criteria are important when determining if a child may warrant "watchful waiting" instead of prescribing an antibiotic for acute otitis media. Low risk with a temperature of less than 39°C (102.2°F), reliable parents with transportation, and being over the age of 2 years are all factors that may indicate that "watchful waiting" can be a safe and effective strategy for managing acute otitis media, given that many cases of the condition can resolve on their own without the need for antibiotics. It is important to assess each child on a case-by-case basis before determining if "watchful waiting" is appropriate.

Question 2

Jaheem is a 10-year-old low-risk patient with sinusitis. Treatment for a child with sinusitis is:&#10;A) Amoxicillin&#10;B) Azithromycin&#10;C) Cephalexin&#10;D) Levofloxacin&#10;

Accepted Answer

Amoxicillin is the first-line treatment for uncomplicated sinusitis in children. It is effective against the most common bacterial pathogens and is well-tolerated with few side effects. Azithromycin, cephalexin, and levofloxacin may be used as alternatives, but they are typically reserved for cases where the child is allergic to penicillin or amoxicillin, or where the infection is not responding to the first-line treatment. Given that Jaheem is a low-risk patient, amoxicillin is the most appropriate choice.

Question 3

Patient education for a patient who is prescribed antibiotics for sinusitis includes:&#10;A) Use of nasal saline washes&#10;B) Use of inhaled corticosteroids&#10;C) Avoiding the use of ibuprofen while ill&#10;D) Use of laxatives to treat constipation&#10;

Accepted Answer

The use of nasal saline washes can help to relieve sinus pressure, thin mucus, and improve overall sinus health.

Answer: C 
 Ibuprofen can increase the risk of stomach bleeding that can occur with some antibiotics, so it is often recommended to avoid using it while taking antibiotics.

Answer: B and D are incorrect 
 Inhaled corticosteroids are used to treat asthma and chronic obstructive pulmonary disease (COPD) and are not typically used for sinusitis. Laxatives are not needed to treat sinusitis and can have side effects such as dehydration and electrolyte imbalances.

Question 4

Whether prescribing an antibiotic for a child with acute otitis media or not, the parents should be educated about:&#10;A) Using decongestants to provide faster symptom relief&#10;B) Providing adequate pain relief for at least the first 24 hours&#10;C) Using complementary treatments for acute otitis media, such as garlic oil&#10;D) Administering an antihistamine/decongestant combination (Dimetapp) so the child can sleep better&#10;

Accepted Answer

Regardless of whether an antibiotic is prescribed or not, it is important to provide adequate pain relief for the child, especially in the first 24 hours. This can help improve the child's comfort and overall well-being. The other options listed (A, C, and D) are not recommended or evidence-based practices for acute otitis media. Using decongestants may not provide significant symptom relief, complementary treatments like garlic oil have not been proven effective, and antihistamines/decongestants may not be appropriate for all children with this condition.

Question 5

The length of treatment for sinusitis in a low-risk patient should be:&#10;A) 5-7 days&#10;B) 7-10 days&#10;C) 14-21 days&#10;D) 7 days beyond when symptoms cease&#10;

Accepted Answer

The length of treatment for sinusitis in a low-risk patient should be 5-7 days. Shorter courses of antibiotics have been shown to be equally effective and reduce the risk of antibiotic resistance. In cases where the symptoms do not resolve after 5-7 days, a longer course may be considered.

Question 6

Jacob has been diagnosed with sinusitis. He is the parent of a child in daycare. Treatment for sinusitis in an adult who has a child in daycare is:&#10;A) Azithromycin 500 mg q day for 5 days&#10;B) Amoxicillin-clavulanate 500 mg bid for 7 days&#10;C) Ciprofloxacin 500 mg bid for 5 days&#10;D) Cephalexin 500 mg qid for 5 days&#10;

Accepted Answer

Sinusitis is usually caused by bacterial infection and Amoxicillin-clavulanate is a first-line treatment for bacterial sinusitis. It covers the most commonly encountered pathogens and is generally well tolerated. Therefore, option B is the best choice for treating Jacob's sinusitis.

Question 7

Myles is a 2-year-old patient who has been diagnosed with acute otitis media. He is afebrile and has not been treated with antibiotics recently. First-line treatment for his otitis media would include:

A) Azithromycin
B) Amoxicillin
C) Ceftriaxone
D) Trimethoprim/sulfamethoxazole

Accepted Answer

Amoxicillin is the preferred first-line treatment for acute otitis media in children under 6 years old who do not have a penicillin allergy and have not been recently treated with antibiotics. Azithromycin would be an alternative option for children with a penicillin allergy or who cannot tolerate oral medications. Ceftriaxone and trimethoprim/sulfamethoxazole are not first-line treatment options for uncomplicated acute otitis media in this age group.

Question 8

Alyssa is a 15-month-old patient who has been on amoxicillin for 2 days for acute otitis media. She is still febrile and there is no change in her tympanic membrane examination. What would be the plan of care for her?

A) Continue the amoxicillin for the full 10 days.
B) Change the antibiotic to azithromycin.
C) Change the antibiotic to amoxicillin/clavulanate.
D) Change the antibiotic to trimethoprim/sulfamethoxazole.

Accepted Answer

If there is no improvement after 48-72 hours of initiation of amoxicillin, changing the antibiotic to amoxicillin/clavulanate is recommended for the treatment of acute otitis media. Azithromycin and trimethoprim/sulfamethoxazole are alternative options if the patient is allergic to penicillins or unable to tolerate them. However, amoxicillin/clavulanate is considered the first-line treatment for acute otitis media in children.

Question 9

First-line therapy for a patient with acute otitis externa (swimmer's ear) and an intact tympanic membrane includes:&#10;A) Swim-Ear drops&#10;B) Ciprofloxacin and hydrocortisone drops&#10;C) Amoxicillin&#10;D) Gentamicin ophthalmic drops&#10;

Accepted Answer

First-line therapy for acute otitis externa with an intact tympanic membrane includes topical antibiotic and corticosteroid drops, such as ciprofloxacin and hydrocortisone drops. Swim-Ear drops are not an appropriate treatment for an infection. Amoxicillin is an oral antibiotic and is not typically used as first-line therapy for otitis externa. Gentamicin ophthalmic drops are not indicated for otitis externa and may cause further damage if used in the ear.

Question 10

Patients who should be cautious about using decongestants for an upper respiratory infection (URI) include:&#10;A) School-age children&#10;B) Patients with asthma&#10;C) Patients with cardiac disease&#10;D) Patients with allergies&#10;

Accepted Answer

Patients with cardiac disease should be cautious about using decongestants for an upper respiratory infection because these medications can increase blood pressure and heart rate, potentially exacerbating cardiac conditions.

Question 11

Caleb is an adult with an upper respiratory infection (URI). Treatment for his URI would include:&#10;A) Amoxicillin&#10;B) Diphenhydramine&#10;C) Phenylpropanolamine&#10;D) Topical oxymetazoline&#10;

Accepted Answer

The answer of Caleb is an adult with an upper...

Question 12

Rose is a 3-year-old patient with an upper respiratory infection (URI). Treatment for her URI would include:&#10;A) Amoxicillin&#10;B) Diphenhydramine&#10;C) Pseudoephedrine&#10;D) Nasal saline spray&#10;

Accepted Answer

The answer of Rose is a 3-year-old patient with an...

Deck 46: Upper Respiratory Infections, Otitis Media, and Otitis Externa